Provider Demographics
NPI:1942353719
Name:FRED T. PULIDO, JR., M.D., P.C.
Entity Type:Organization
Organization Name:FRED T. PULIDO, JR., M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GENIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FACEMYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-345-5466
Mailing Address - Street 1:1213 VIRGINIA ST E
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2908
Mailing Address - Country:US
Mailing Address - Phone:304-345-5466
Mailing Address - Fax:
Practice Address - Street 1:1213 VIRGINIA ST E
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2908
Practice Address - Country:US
Practice Address - Phone:304-345-5466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty